Abstract
Brandon F. Greene conducted an accumulation of research studies with his team at Project 12-Ways which served to improve the lives of families with a history of child maltreatment. Greene outlines his findings in Behavior Analysis Metrics & Applications for the Preservation & Reunification of Families. Over the course of his tenure, Greene assisted in the development of a robust collection of Behavior Analytic Metrics and Applications (BAMA) which function to provide a comprehensive assessment and streamlined treatment of common problems presented by families within the child welfare system. Greene best describes BAMA as a “worm’s-eye view of the change that can be effected in the daily lives of families with a history of child maltreatment” (p. xi) emphasizing the necessity of a microlevel approach to affect meaningful change with the families served.
In the first section of the book, Greene stresses that effective treatment involves more than simply addressing the parent–child relationship, it must also include all facets of the families’ circumstances which make up the behavioral ecosystem in which they live. In order to more effectively treat breakdowns within these ecosystems, intervention must take place within the home rather than office or clinic setting. This tenant is supported by literature cited by Greene indicating that therapeutic change effect often does not spontaneously transfer across settings (Patterson, 1982). Although these in-home services may be highly efficacious, Greene references work by Goldstein et al. (1984), which asserts that home intrusions by the state should be kept to a minimum as even brief presence with the purpose of providing assistance could compromise the family. Informed by the work of Goldstein et al., the U.S. Congress passed the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 functioning as a template for states in defining and responding to child abuse and neglect. CAPTA also requires that states make “reasonable efforts” to keep families intact, to develop a permanency plan outlining efforts made, and to create a set of minimum parenting standards for determining child placement.
Greene argues that while useful, the guidelines set by CAPTA leave room for interpretation, necessitating a metrics system that utilizes behavioral measurement to assess and treat child maltreatment. Throughout the remainder of the book, Greene outlines research conducted by himself and his team aimed at designing processes and procedures to treat both widespread and specialized concerns present in families with a history of child maltreatment.
The second section of the book outlines various assessments and interventions targeting improvements in the families’ homes. In an effort to reunite or keep families intact, Greene asks “how good do parents have to be?”; a question to be informed by behavior analytic assessments. In regard to home cleanliness, Greene outlines his Checklist of Living Environments to Assess Neglect, which uses normative data to determine the acceptability of household conditions. To investigate other variables pertaining to home safety, Greene cites the Home Accident Prevention Inventory (HAPI; Tertinger et al., 1984), which assesses the risk of potential environmental hazards within the home. After continued investigation and application of the HAPI, Greene presents limitations regarding its external validity and duration of assessment which led to the development of the more streamlined Home Safety Rating Scale (HSRS). Direct testing of the HSRS indicated that it was sensitive to changes in environmental hazards within the homes.
The third section addresses identification and treatment of basic caregiver responsibilities. Greene outlines a case study conducted by himself and colleagues (1995), which successfully utilized task analyses to train caregivers in various aspects of childcare such as diapering and feeding of infants as well as another study involving responding appropriately to injuries. After observing a high prevalence of domestic violence within families served, Greene developed a tool for training families to respond appropriately in the event of an intrusion. Lund and Greene (2003) investigated the use of individualized task analyses and role play with families with a recent history of domestic violence or threats of child abduction. Following training, increases were observed in the families’ abilities to respond in such a way that represents the best chance of remaining safe. Greene also outlines the use of Virtual Self-Modeling (VSM; Happe, 2004), which involves the use of an avatar depicting the participant which he or she can manipulate to perform various responses. His team showed that VSM was effective at both teaching children to evade lures within the community as well as respond appropriately to callers requesting personal information while home alone.
The fourth section discusses various tools utilized to promote family preservation. Greene argues for the use of Critical Family Periods and Contextually Valid Family Training, which emphasizes the embedding of assessment and intervention to times, locations, people, and activities that a particular family’s history suggests are of concern. While outlining a case involving a mother and child with Tourette’s Syndrome as well as serious behavior challenges, Greene demonstrates the use of “staff as parent,” wherein a staff member served the role of the parent. The staff member utilized the leanest degree of behavioral management necessary, which was later transferred to the caregiver.
The DCFS cases often fail to provide a comprehensive family history when providing treatment. Greene emphasizes the need for this family history and thus developed new protocols for gathering that information. In order to gain a description of family daily routines and stress levels associated with those activities, they developed the Stress and Routine Assessment. With this information, the team was able to select individualized goals and begin the establishment of consistent routines that facilitated more pleasant interactions through tools such as the Systematic Training and Routine Reconstruction. In order to gain an understanding of current interactions, the Systematic Observation of Family Interactions was developed to assess and measure the quality of parent–child interactions including areas such as positive and negative vocalizations and touch, affect, parent instruction, and child compliance.
Family reunification serves as the initial goal during circumstances in which children have been removed from their homes due to abuse allegations. The fifth section discusses this process and the importance of doing so carefully to avoid the potential disastrous effects of a poorly calculated parental restoration. The Progressive Visitation Contract was developed to systematically transition from supervised visitation to reunification in an effort to ensure that any possible failures to reunify would be controlled failures, not catastrophic ones. Greene outlines a study conducted by himself and colleagues (1995), which presents a clever method for quantifying parent motivation to regain custody of their children. This method involved the use of a contract for visitation which cited necessary cleaning tasks and measurement of the degree of generalization to other noncontracted tasks. A final area investigated the facilitation of a smooth transition between residential placement and home settings. In order to achieve this, the staff measured environmental features in both settings and established home routines to mimic that of the residential setting to help bridge the gap between the two settings.
In the sixth section, Greene investigates critical periods that pertain to various family leisure activities. His team often observed that children who were victims of abuse and neglect displayed an increased tendency to mistreat their pets. This led them to develop the Indoor Care for Dogs Checklist, the Systematic Observation of Child-Dog Interactions, and the Caged Bird Care Checklist. Families frequently reported child problem behavior during shopping trips. Greene outlines a study in response conducted by Clark et al. (1977) during which his team developed and trained parents in General Child Management which included the use of manual guidance, time-out, differentia praise, and planned ignoring. Parents were also provided the Shopping with Children: Advice for Parents Guide (Greene et al., 1977) and instructed to apply recommendations while shopping. Results indicated the intervention effectively increased parent teaching comments and child appropriate statements as well as decreased child distracting comments and distracting behaviors.
Assertiveness, self-protection, and problem-solving skills play a critical role in ensuring safety and well-being. In the seventh section, Greene first outlines an assertiveness training conducted with mothers who experienced a history of physical abuse by their partners. His team developed an Assertiveness Protocol which measured 11 specific “body language” and communicative behaviors. Role play scenarios were created based on each participant’s individualized circumstances and training conducted through modeling, practice, and feedback. They were also trained to collect data using this protocol on their own behavior to provide measurement during in situ occurrences to ensure mastery had been achieved in the natural setting which required assertive behaviors. This training was used in a subsequent intervention involving victimized adolescent girls with the inclusion of a social validity measure obtained through having independent professionals with experience in women’s shelters, counseling, and assertiveness training score the adolescents performance. Although increases were observed in the Assertiveness Protocol, increased ratings from baseline to posttreatment were not consistently observed, emphasizing the need for additional investigation. Greene next discusses the need for an assessment protocol to detect women’s vulnerability to exploitation leading his team to develop the Categorical Assessment of the Risk of Exploitation with which women were provided scenarios and responses scored based on their ability to detect a problem, articulate insight on the scenario, and provide an appropriate solution.
Greene highlights that much of the research in the areas of training children to escape or avoid and respond appropriately to sexually exploitative situations lacks contextual validity as it often includes asking the child to label “good touch” and “bad touch” which would likely not occur in a moment of sexual assault. Instead, Greene and his team developed the Awareness and Response Training to assess and teach children to respond to inappropriate touch through the use of anatomically correct dolls. Following the occurrence of a sexually inappropriate touch, the children were taught to state “no,” remove the doll from the area, and report the incident to a safe adult.
In the eight section, Greene discusses two unique challenges observed in the families they served and the systems developed to mitigate those areas of concern. The first involved children who displayed reading deficits that were not currently being addressed within their school education. Through the use of direct instruction (Engelmann, 1968), all of the children displayed increases in their reading abilities. The second challenge involved a case study of a 7-year-old girl with primary encopresis. Their intervention utilized frequent dry pants checks and the use of a scatter plot depicting elimination in both clothing and toilet. Following over a year of treatment, the participant was successfully eliminating only in the toilet.
Greene next discusses staff training, supervision, and systemic failures in the ninth section. Greene emphasizes the necessity of sufficient training and supervision in the provision of effective services stating “the problem is often that good people (many with advanced degrees) are in a bad system” (p. 316). He outlines an initiative funded by DCFS aimed at promoting training and related activities during visitations following the Bates, Saunders versus Johnson lawsuit in which parents successfully argued that DCFS had failed to provide reasonable opportunities for visitation with their children. Greene provides procedures to guide caseworkers through planning, executing, and concluding visits. The Home Evaluation and Learning Program was designed to assist caseworkers in focusing on planning activities related to basic skills necessary in establishing parental capacity. The Visitation Intervention Program is a comprehensive training utilized to assist caseworkers in the development of critical skills regarding parental visits and included mastery criterion before completion. After a subsequent lawsuit (Bates, Saunders & Others v. Illinois Department of Children and Family Services) in which parents argued that their right to reasonable visitation had been violated, Greene was appointed special master to determine the extent to which DCFS had failed to fulfill their obligation. Greene employed the use of BAM on a large scale tracking the proportion of visitation fulfilled as specified, the amount of unsuccessful attempts to arrange visits as well as supervisory contacts with caseworkers. Results indicated DCFS required an ongoing performance management system that facilitated monitoring, support, and direction in regard to visitation and reunification.
After a successful overhaul of the DCFS system, Greene and his team determined that it would be beneficial to utilize what had been effective within their own company. They developed the Staff Agenda Planning Intervention, a checklist containing critical tasks within staging, executing, and debriefing sessions to ensure integrity and consistency among staff. In order to promote effective training, they created a manual which emphasized pyramidal training, a particularly beneficial component as the company primarily employs graduate students who cycle through during their tenure.
In the tenth and final section of his book, Greene presents a broader view of the services his team provides. As many families within the system receive income through their children, Greene discusses an intervention which encourages vocational and avocational pursuits. This involved the Survey of Avocational and Vocational Interests, developed to determine volunteer and employment history and obstacles reported in pursuing them. After selecting an activity, the team provided guidance via checklists utilized to measure progress. Greene concludes his book by outlining a comprehensive replication of the 12-Ways program at the Children’s Aid Society (CAS) in Ontario, Canada. Staff were transferred to CAS to train the employees in the full battery of protocols developed. Results indicated they were successful in promoting perseveration and reunification among the families served.
In Behavior Analysis Metrics & Applications for the Preservation & Reunification of Families, Greene provides a succinct yet thorough overview of the innovative research conducted by his team. He outlines inventive solutions to areas of concern within the families served, providing an ideal model of the creative problem-solving that therapeutic service providers should work to develop. His emphasis on behavior analytic measurement, assessment, and intervention is clearly indicated within his own research and resulting protocol development. With a clear outline of rationale and methodology, his procedures can be easily followed and adapted among both behavior analytic and nonbehavior analytic practitioners. Behavior Analysis Metrics & Applications for the Preservation & Reunification of Families is an essential read for service providers who work closely with families, providing both specific solutions to problems and an understanding of the problem-solving process.
